Evaluation and Management of Migratory Polyarthralgia in Males

Diagnostic Considerations

The American Heart Association suggests that in a male patient presenting with migratory polyarthralgia, the primary diagnostic consideration is acute rheumatic fever (ARF) if the patient is from a moderate- or high-risk population, followed by a systematic exclusion of inflammatory arthritides, infections, and systemic diseases 1
Acute rheumatic fever presents with classic migratory polyarthritis that is highly responsive to salicylates and NSAIDs, often moving from joint to joint over hours to days 1
The American College of Cardiology recommends documenting specific features to guide diagnosis, including duration and pattern, response to NSAIDs/salicylates, recent streptococcal infection, and geographic origin 1

Inflammatory markers such as ESR and CRP are essential and confirm inflammatory process 2, 3
Anti-streptolysin O (ASO) or anti-DNase B titers should be measured to support recent streptococcal infection in suspected ARF 1
Rheumatoid factor and anti-CCP antibodies should be measured to exclude rheumatoid arthritis 2

The American Heart Association recommends that for suspected acute rheumatic fever, anti-inflammatory therapy should not be initiated until diagnosis is confirmed, as this masks the migratory pattern and diagnostic features 1
Once ARF is confirmed, salicylates or NSAIDs should be started for arthritis, and corticosteroids should be considered only for severe carditis 1
Antibiotic prophylaxis with penicillin should be initiated to prevent recurrent ARF 1

Rheumatology referral is indicated for positive autoantibodies, persistent inflammatory arthritis, or diagnostic uncertainty 3
Cardiology referral is indicated for suspected ARF with cardiac involvement or new murmur 1
Infectious disease referral is indicated for suspected endocarditis or atypical infection 1